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ANORECTAL DISORDERS.

ANORECTAL DISORDERS. Gastroenterology Rao, S. S., Bharucha, A. E., Carrington, E. V., Grossi, U., Malcolm, A., Neshatian, L., Remes-Troche, J. M. 2026

Abstract

This article defines diagnostic criteria, and reviews clinical evaluation and management of fecal incontinence, anorectal pain, dyssynergic defecation (DD), and rectal hyposensitivity and hypersensitivity. Diagnostic evaluation includes anorectal manometry, balloon expulsion test (BET), anal ultrasound, magnetic resonance imaging, defecography and neurophysiology testing. FI is defined as recurrent uncontrolled passage of fecal material for 3 months. Management includes antidiarrheals, Kegels exercise, biofeedback therapy, dextranomer injection, surgery, sacral nerve stimulation and translumbosacral neuromodulation therapy (TNT). Anorectal pain lasting seconds to minutes is defined as proctalgia fugax whereas pain lasting more than 30 minutes with puborectalis tenderness is defined as levator ani syndrome. Biofeedback and TNT may be useful. DD is defined by both symptoms of difficult defecation and objective evidence of dyssynergia. Biofeedback therapy is efficacious in DD. Rectal sensory disorders are defined by both anorectal symptoms and increased (hyposensitivity) or decreased (hypersensitivity) sensory thresholds during rectal balloon distension, and sensory biofeedback is useful.

View details for DOI 10.1053/j.gastro.2026.01.037

View details for PubMedID 41713710